Cecilia Pompili1, Frank Detterbeck2, Kostas Papagiannopoulos3, Alan Sihoe4, Kostas Vachlas3, Mark W Maxfield2, Henry C Lim4, Alessandro Brunelli3. 1. Department of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy. Electronic address: ceciliapompili@gmail.com. 2. Department of Thoracic Surgery, Yale-New Haven Hospital, Yale University, New Haven, Connecticut. 3. Division of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom. 4. Department of Thoracic Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Abstract
BACKGROUND: The aim of this study was to assess the impact of digital versus traditional drainage devices on chest tube removal and patient satisfaction. METHODS: A randomized trial of digital versus traditional devices after lobectomy/segmentectomy was conducted at 4 international centers (United Kingdom, Europe, Asia, United States). Patients were managed with overnight suction followed by gravity drainage. Chest tubes were removed when an air leak was not evident anymore and the drained fluid was less than 400 mL/d. RESULTS: The groups (digital, 191 patients; traditional, 190 patients) were well matched for baseline and surgical characteristics. There were 325 lobectomies/bilobectomies and 56 segmentectomies, 308 of which were performed by video-assisted thoracic surgery (VATS). Patients randomized to digital systems had a significantly shorter air leak duration (1.0 versus 2.2 days; p=0.001), duration of chest tube placement (3.6 versus 4.7 days; p=0.0001), and postoperative length of stay (4.6 versus 5.6 days; p<0.0001). Subjective end points revealed a perceived improved ability to arise from bed (p=0.008), system convenience for patients and personnel (p=0.02), and the potential for being comfortable when discharged home with the device (p=0.06). A mean difference of 2.6 days from air leak cessation to tube removal was observed, which was similar in the 2 groups (p=0.7). Multivariable regression analysis showed that duration of chest tube placement after air leak cessation was directly associated with the amount of fluid drained during the first 48 hours (p=0.01) and the duration of air leak (p=0.008), independent of hospital location. CONCLUSIONS: Patients managed with digital drainage systems experienced a shorter duration of chest tube placement, shorter hospital stays, and higher satisfaction scores compared with those managed with traditional devices. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT01747889.).
RCT Entities:
BACKGROUND: The aim of this study was to assess the impact of digital versus traditional drainage devices on chest tube removal and patient satisfaction. METHODS: A randomized trial of digital versus traditional devices after lobectomy/segmentectomy was conducted at 4 international centers (United Kingdom, Europe, Asia, United States). Patients were managed with overnight suction followed by gravity drainage. Chest tubes were removed when an air leak was not evident anymore and the drained fluid was less than 400 mL/d. RESULTS: The groups (digital, 191 patients; traditional, 190 patients) were well matched for baseline and surgical characteristics. There were 325 lobectomies/bilobectomies and 56 segmentectomies, 308 of which were performed by video-assisted thoracic surgery (VATS). Patients randomized to digital systems had a significantly shorter air leak duration (1.0 versus 2.2 days; p=0.001), duration of chest tube placement (3.6 versus 4.7 days; p=0.0001), and postoperative length of stay (4.6 versus 5.6 days; p<0.0001). Subjective end points revealed a perceived improved ability to arise from bed (p=0.008), system convenience for patients and personnel (p=0.02), and the potential for being comfortable when discharged home with the device (p=0.06). A mean difference of 2.6 days from air leak cessation to tube removal was observed, which was similar in the 2 groups (p=0.7). Multivariable regression analysis showed that duration of chest tube placement after air leak cessation was directly associated with the amount of fluid drained during the first 48 hours (p=0.01) and the duration of air leak (p=0.008), independent of hospital location. CONCLUSIONS:Patients managed with digital drainage systems experienced a shorter duration of chest tube placement, shorter hospital stays, and higher satisfaction scores compared with those managed with traditional devices. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT01747889.).
Authors: Pier Luigi Filosso; Victor Auguste Nigra; Giovanni Lanza; Lorena Costardi; Giulia Bora; Paolo Solidoro; Riccardo Carlo Cristofori; Massimo Molinatti; Paolo Olivo Lausi; Enrico Ruffini; Alberto Oliaro; Francesco Guerrera Journal: J Thorac Dis Date: 2015-10 Impact factor: 2.895